The realities of life as a stay-at-home parent with a spouse in medical residency and fellowship at MGH/Dana-Farber. With lots of my best-find recipes thrown in.

Married to Medicine

Thursday, January 9, 2014

Why The Press Shouldn't Be Your Source For Medical Advice

Perhaps you read the Huffington Post article "Why The Press Shouldn't Dismiss Vaccine Skeptics" by Lawrence Solomon. In it, Mr. Solomon concludes with the worthy (if not lofty) goal that we should spend a lot of research dollars "identifying vulnerable populations" so that "all can be confident when vaccines are administered." (Lofty I say, because study after study has shown that vaccinated children are at no higher risk for autism than are unvaccinated children, and severe vaccine reactions - or reports alleging the same - remain almost entirely without causal verification and number fewer than one per million for most childhood vaccines).

The rest of his article drops a few names, and attributes a few out-of-context quotations. For example, he claims that Dr. Diane Harper, one of the lead developers of Gardasil, "believes [the vaccine] is less effective than the common pap smear, and that it may harm more children than it helps." He doesn't link to any transcript of her saying any such thing, and as far as I can tell from Snopes there's a pretty good reason for that [Correction: Since I first published this entry, he changed his hyperlink to direct to an article by a known anti-vaxxer who seems to parrot the debunked statements]. Let's look at what Dr. Harper actually says about the vaccine versus what Mr. Solomon says she "believes." It's class anti-vaxx twisting:

According to Snopes, and to another more in-depth discussion here, Dr. Harper has said: "Cervarix is an excellent choice for both screened and unscreened populations due to its long-lasting protection, its broad protection for at least five oncogenic [read: cancer-causing] HPV types, the potential to use only one dose for the same level of protection, and its safety." She did speculate that cervical cancer screening may be just as effective in preventing cervical cancer, and she expressed concern that vaccinated women would fail to use other protection and/or to follow-up with annual pap smears, which would remain important for detecting rarer strains of HPV not covered by the vaccine. She finally went on to recommend expanding the guidelines for HPV vaccines for older women (in other words, using it more often). And yes, there is continued confusion over Dr. Harper's views on the effectiveness of the vaccine 5+ years after it is administered (because current research shows that it is highly effective longer-term - see the link and the comments section).

Hmmm. A pretty far cry. Any innocent reader who didn't dig beyond Mr. Solomon's article would walk away thinking "The very creator of the HPV vaccine doesn't think it's the most effective option and thinks it may harm more children than it helps. Guess I won't be using that!" In reality, Dr. Harper's statements have been a ringing endorsement of the vaccine. Plus, anyone with a little medical knowledge will tell you that even if pap smears are highly effective at detecting precancerous cervical cells, they cannot be done to detect and prevent the oral, penile, or anal cancers also caused by HPV. Oral HPV-acquired head and neck cancers are fast becoming a major concern; when my husband did his head-and-neck cancer rotation back in 2006, already about half the patients were tobacco users and half had oral HPV-acquired cancer. To say nothing of the idea that perhaps preventing HPV in the first place is more appealing than acquiring it and catching precancerous cells at one's annual pap smear - and continuing to spread it.

That twisting alone made me highly suspicious of the article and its author. That's why I want to share with you the exchange I had with him in the comments section.

Commenter A: When 97 scientists say these vaccines are better than no vaccines, and 3 scientists say no to vaccines, I don't think we need balanced reporting or respect for the no-side. They are simply wrong with potentially dangerous effects.Mr. Solomon: Can you point me to the survey or study that indicates a 97%-3% split among scientists? Was the question as black and white as you suggest or could a scientist have answered that some vaccines help some populations but not others?Me: Here's a study that shows that 97% of physicians vaccinate their own children: (This study shows that 95+% of pediatricians polled in Switzerland - which included a 95% response rate among pediatricians there - vaccinate their own children, and that physicians are more likely than non-physicians to vaccinate still more for other diseases not included on the schedule, like Lymes Disease).

Mr. Solomon: Thank you very much for this 2004 study, which I had not seen. It shows that pediatricians in Switzerland generally follow the recommended schedule, but not slavishly. And other physicians (non-pediatricians) are less likely to do so.

In the case of vaccines that are not recommended by the authorities (the Swiss vaccinate much less than we do), the majority of pediatricians and non-pediatricians stay away from most of the vaccines.

Me: Actually, that is not true. We have one extra Hep B and one extra PCV, and we vaccinate for Hep A. But the Swiss show 2 more IPVs and 1 more MMR. Did you see a vaccine "not recommended by the authorities" in Switzerland that we do vaccinate for other than Hep A? I didn't.

You'll see that the vaccination schedules for both Canada and the US are much longer than in Switzerland.

Me: This is a good example of why non-physicians and non-scientists have difficulty assessing the vaccine situation. The tables above are confusing because of overlap; if you look carefully you will see that the only diseases we vaccinate for that they do not vaccinate for are:

(1) Rotavirus and Hep A, which are a concern for nations including significant migrant and inner-city poor populations - a good example of how, far from mindless and unmonitored, each nation accounts for its population when its experts come out with their best schedule; and

(2) They don't recommend the flu vaccine until the age of 65. Surely though, the current news in the U.S. is enough support for our schedule here.

The other differences are minor differences I already listed above. The Swiss actually give two different meningococcal vaccines whereas we give 1. We give 1 extra HPV but are considering reducing to 2 as more evidence emerges that 2 is safe. We give one more pneumoccocal.

The point being that the study I provided shows that 95+% of pediatricians vaccinate their children. I don't know of a similar study done in the US but it seems anti-vaxxers are more likely to trust physicians of other nations anyway. Do you have a study showing anything otherwise? My father is nearing retirement as a physician/professor at UW-Madison and has seen tens of thousands of vaccinations. He has never once seen a dangerous reaction, and he hasn't seen HIB deaths since we started vaccinating for it.

So there you go. Perhaps the press shouldn't dismiss vaccine skeptics. But they should certainly do a better job of presenting their misleading, distorted, and in some cases simply false "information" as factual and objective. The above exchange shows the classic twisting of anti-vaxx logic. A study showing near unanimity in physicians supporting their nation's vaccine schedule that is nearly identical to ours - and is identical on the controversial vaccines - is made out to be a potential reason not to vaccinate. And the fact that physicians are more likely than non-physicians to add still more vaccines (like the Tick-Borne Encephalitis vaccine) is twisted to somehow say something alarming about our own vaccine schedule. It's almost amazing, really!

Here is an excellent response to the article, from the professor who runs "Informed Parents of Vaccinated Children" ("like" the Facebook page to get the most recent vaccine news coverage and studies in your Facebook feed ... or ask them your questions, she'll respectfully respond).

Asking questions about vaccine safety is both important and appropriate - and done by scientists and the public alike. That's not why anti-vaccine activists are dismissed. They're dismissed because they reject valid answers because of conspiracy theories. They're not interested in improving vaccine safety, but in getting rid of vaccines - based on false information and unsupported fears - without proposing an alternative to protect children from disease. They ignore the data. They resort to conspiracy theories and personal attacks.

When serious scientists point out real problems with vaccines, they are not dismissed - like the recent narcolepsy connected to H1N1 or the problems with the first rotavirus vaccine. When scientists or others misrepresent data, do flawed research, when others reject abundant data based on global conspiracy theories, they are appropriately marginalized and criticized.

Last, please note that Mr. Solomon's article cites with approval a research team funded by wealthy anti-vaccine foundations. The papers produced by Chris Shaw and Lucija Tomljenovic have been rejected by mainstream scientists as remarkable for sloppy methods and weak non-scientific reasoning. See the first comment below for more information and sources.

The GACVS reviewed 2 published papers alleging that aluminium in vaccines is associated with autism spectrum disorders and the evidence generated from quantitative risk assessment by a US FDA pharmacokinetic model of aluminium-containing vaccines.

GACVS considers that these 2 studies are seriously flawed. The core argument made in these studies is based on ecological comparisons of aluminium content in vaccines and rates of autism spectrum disorders in several countries. In general, ecological studies cannot be used to assert a causal association because they do not link exposure to outcome in individuals, and only make correlations of exposure and outcomes on population averages. Therefore their value is primarily for hypothesis generation. However, there are additional concerns with those studies that limit any potential value for hypothesis generation. These include: incorrect assumptions about known associations of aluminium with neurological disease, uncertainty of the accuracy of the autism spectrum disorder prevalence rates in different countries, and accuracy of vaccination schedules and resulting calculations of aluminium doses in different countries.

Orac Knows (pseudonym for a breast cancer researcher-surgeon) Respectful Insolence, And Global Warming Is Casued by the Decerease in Pirates http://scienceblogs.com/insolence/2011/12/08/and-global-warming-is-caused-by-the-decr/

Orac Knows (pseudonym for a breast cancer researcher-surgeon) Respectful Insolence, And Now, Death By Gardasil, Again Not So Fast… http://scienceblogs.com/insolence/2012/10/31/and-now-death-by-gardasil-again-not-so-fast/

Just finished reading, vary nice rebuttal, especially the back and forth that sited and asked for documentation. Children die around the world from measles multiple times per minute, but we don't see it here, so we don't see it at all. And then we ask why am I taking these shots, for diseases so rampant one generation ago...

I believe it was put best thus, "People don't like big pharma and big government providing them with data, and many of us can't digest it themselves. So they prefer anecdotal evidence, which makes up for it's lack of evidence through fear, and so we believe it. And we see people running from big pharma and big government right into the arms of big placebo."

You're fighting the good fight (and doing it well!), for which I heartily applaud you. For those out there still on the fence about vaccines, searching for information before making up their mind, I hope they find these articles to be a beacon of light being shed on the nonsense being spread about supposed dangers of vaccines.

But I have to say, as a pediatrician in a state with abysmal vaccination rate due to high number of parental opt-outs, that the quote from the professor was spot on:

"... they reject valid answers because of conspiracy theories. They're not interested in improving vaccine safety, but in getting rid of vaccines - based on false information and unsupported fears - without proposing an alternative to protect children from disease. They ignore the data. The resort to conspiracy theories and personal attacks."

(and fully agree with the quote by Jeff, commenter above)

The core group of anti-vaccinators are completely uninterested in data, science, facts or reason. They carry a BELIEF which can't be shaken by discourse. They have strong FEELINGS about it, not strong arguments. So no matter how smartly we present them with data, research studies, population statistics, it doesn't seem to make a beans of difference. And honestly just feels like banging my head against a wall.

"no matter how smartly we present them with data, research studies, population statistics, it doesn't seem to make a beans of difference"You might investigate the Socratic method. That's a technique where rather than presenting someone with an argument, you ask questions to get them to think. It can help in getting irrational people to think.

Those who are labelled as anti-vaccination rogue scientists are hardly rogues -- they are found at the pinnacle of the medical establishment. And they are hardly anti-vaccination. All of the scientists that I mention in this article value vaccines for the great good that they can do..

Oopsie. Harper is becoming more stridently anti-vaccine, and Shaw and Tomjlenovic have yet to identify a vaccine they support.

It's also interesting to note that Solomon denies the dangers of anthropogenic climate change.

I agree, although it's true that anti-vaxxers are less likely to trust U.S. medicine than medicine practiced in other Western nations. But maybe a scientist reading this will run a similar study. I would imagine that the size of our nation alone makes it more difficult to get a response rate of close to 100% ... maybe that's why we don't have it.

I have so appreciated the series you've written on vaccinations! I am a doula and hear many conspiracy theories. It can be hard for some to find an easy to understand and personal explanation about the dangers of not vaccinating. I could go on, :) but thanks for providing such a great resource.

Solomon appears to have no post-secondary education in science or medicine. His biographical information lists nothing about such qualifications. He claims to be an "environmentalist" but, again, lists no relevant studies or training. His book on global warming (The Denialists) is mostly about the "maverick" scientists who dispute anthropegenic global climate change. Looks like he's transferring this schtick to the vaccination issue.

Makes perfect sense to me. "The Swiss vaccinate much less than we do." Perfect example of anti-vax rhetoric that just gets repeated and repeated but never actually checked into. Thanks for reading - and for pointing out the lack of credentials.